Tacrolimus in pediatric heart transplantation: ameliorated side effects in the steroid‐free, statin era

Abstract

Due to concerns over the side effects of cyclosporine, tacrolimus is widely used in pediatric heart transplantation. However, tacrolimus therapy is also accompanied by potentially serious side effects. This paper examines the side effect profile of tacrolimus in a large group of pediatric heart recipients. Data on renal function, diabetes, hyperlipidemia and hypertension were collected by case-note review of 100 patients who had received . OR = 12 months treatment with tacrolimus. Forty-two patients received tacrolimus from the time of transplant (de novo), and 58 were initially treated with cyclosporine (switch). Mean estimated glomerular filtration rate improved in the first six months post transplant in the de novo group (66.7-84.6 mL/min/1.73 m2, p = 0.002). Conversely, it decreased in those initially treated with cyclosporine (82.1-68.8, p = 0.032), but improved after switch to tacrolimus (77.3-85.6, p = 0.006). Twenty-one percent exhibited glucose intolerance, and 2% had diabetes. Borderline or elevated fasting cholesterol levels were present in 4.4%. Hypertension was seen in 67% at the point of switch from cyclosporine, which fell to 36% at latest follow-up (p = 0.001). These results present an encouraging outlook for this cohort of patients. The relatively low levels of complications shown may be due to early weaning of steroids, and concomitant statin therapy.

Treatment with Immunosuppressants FTY720 and Tacrolimus Promotes Functional Recovery after Spinal Cord Injury in Rats

“…The effect of immunosuppression as a therapy for SCI could be explained by these observations. Tacrolimus (also called FK506), a kind of macrolides immune inhibitor, is widely used in organ transplantation (Fukudo et al 2009;Simmonds et al 2009). It can promote physiological functional recovery of transplanted allogeneic limbs (Dubernard et al 2003), and improve the locomotor function of limbs after SCI (Madsen et al 1998;Voda et al 2005;Pan et al 2006a) In the present study, it was also found that tacrolimus effected statistically significant improvements after SCI, as quantified by the BBB score, the inclined plane test, footprint analysis, electrophysiological tests and electron microscopic analysis.…”

Prevalence of renal dysfunction in tacrolimus‐treated pediatric transplant recipients: A systematic review

“…After removing all duplicates and papers not meeting the inclusion criteria, eighteen papers were considered relevant. Twelve papers reported on liver, one on combined heart and lung transplant , four on heart transplant , and one on intestinal transplant recipients (Fig. ) .…”

“…We identified five papers reporting on renal function after transplantation in either heart and lung transplant recipients or heart transplant recipients published between 1999 and 2011 (Table ). Ages ranged from seven hours until 18 yr. Four papers used the age‐ and gender‐adjusted Schwartz formula to calculate the GFR; one of these used a cutoff criterion to determine CKD . The prevalence of CKD in these papers ranged from 6.8% to 46% with a follow‐up time ranging from 14 days post‐transplantation to seven yr post‐transplantation.…”

“…The prevalence of mild CKD at least one yr post‐transplantation ranged from 22.7% to 40%, and that of severe CKD ranged from 6.8% to 46% .…”

Immunosuppression Therapy for Pediatric Heart Transplantation

“…Tacrolimus is now the most commonly used CNI in pediatric heart transplantation in North America. Conversion from cyclosporine to tacrolimus may be helpful to ameliorate specific side effects, such as hirsutism and gingival hyperplasia [11,29].…”